tbuckley/cabot-search huggingface dataset:
POS0678 PERFORMANCE OF CLINICAL, LABORATORY AND IMAGING FEATURES FOR THE DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS - A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Authors: A. D. Vieira Bento Silva, M. H. Fernandes Lourenco, S. Ramiro, L. Falzon, J. Branco, D. Van der Heijde, R. B. M. Landewé, A. Sepriano
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The Berlin algorithm for axial spondyloarthritis (axSpA) diagnosis was developed more than 15 years ago. New evidence suggests that the diagnostic performance of some SpA features might not be as good as initially thought. <h3>Objectives</h3> To review the evidence on the performance of SpA features for axSpA diagnosis. <h3>Methods</h3> Systematic literature review and meta-analysis of studies (2004-2021) reporting data on ≥1 SpA feature. The population was defined as adults (≥16 years) with a suspicion or definite clinical diagnosis of axSpA. The diagnostic performance of each SpA feature was tested against the physician diagnosis of axSpA. For each feature, if ≥2 studies analysed the same cohort, the one with the highest number of patients was included. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) were calculated. Sensitivity analyses were performed to assess the effect of covariates, like feature prevalence in the studies, on the diagnostic performance of SpA features. <h3>Results</h3> In total, 21 studies (19 cohorts) were included, comprising 8574 patients (4089 [48%] with axSpA). Table 1 shows the results of the meta-analysis. Inflammatory back pain (IBP) and good response to nonsteroidal anti-inflammatory drugs (NSAIDs) have low LR- (0.3), meaning that the diagnosis of axSpA is less likely when absent; however, if present they are not helpful in making a diagnosis (LR+ ~1). Peripheral features, extra-musculoskeletal manifestations (EMM) and preceding infection may help in the diagnosis of axSpA when present (LR+ 1.7-4.2), but have little value in its exclusion when absent (LR- 0.8-1.0). Imaging features, elevated C-reactive protein (CRP) and HLA-B27 have good diagnostic performances, reflected by their high LR+ (2.7-17.7) and (relatively) low LR- (0.5-0.7). In a sensitivity analysis the specificity of IBP was lower in studies with high prevalence of this feature (24% versus 78% in studies with low prevalence). The same was observed for buttock pain, peripheral features, uveitis, good response to NSAIDs, elevated CRP and HLA-B27. <h3>Conclusion</h3> Imaging features, HLA-B27 and elevated CRP have high diagnostic value, even though circularity cannot be ruled out. However, HLA-B27, with a LR+ of 2.7, has a worse diagnostic performance than earlier considered. When present, peripheral features and EMM importantly increase the probability of axSpA, while IBP and good response to NSAIDs do not, but are helpful in ruling out the disease when absent. The diagnostic value of most SpA features is somewhat lower compared to previous data. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0966 THE RISK OF INFLUENZA IN PATIENTS WITH SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES- FOCUS ON PRIMARY SJOGREN’S SYNDROME, POLYMYOSITIS/DERMATOMYOSITIS AND SYSTEMIC SCLEROSIS
Authors: I. P. Lee, F. Y. Wu, C. F. Su, S. H. Lin, Y. S. Chang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Influenza vaccine is recommended in patients with most systemic autoimmune rheumatic diseases (SARDs). However, the risk of influenza was less studied in the SARDs other than rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). <h3>Objectives</h3> This study aimed to investigate the risks of influenza-related hospitalization in patients with SARDs, including primary Sjogren's syndrome (pSS), polymyositis/dermatomyositis (PM/DM), systemic sclerosis (SSc), RA and SLE. <h3>Methods</h3> This is a nationwide population-based cohort study analyzing the National Health Insurance Database in Taiwan. Patients with catastrophic certification of each SARD were identified. The risks of influenza-related hospitalization in patients with each SARD were compared with their age- and sex-matched non-AIIRD cohort (1:2). Incidence rates (IR) with incidence rate ratios (IRR) in various AIIRDs were analyzed. <h3>Results</h3> Totally, 48,905 patients with RA, 24,143 patients with SLE, 16,891 patients with pSS, 2,633 patients with SSc and 2561 patients with PM/DM were identified, with basic characteristics shown in table 1. The IR of hospitalization due to influenza was highest in patients with PM/DM (Figure 1) followed by pSS, SSc, SLE and RA. In comparison with their age- and sex-matched controls, the risk was highest in patients with PM/DM with an IRR of 16.83, followed by patients with SSc, pSS, SLE and RA. <h3>Conclusion</h3> Patients with PM/DM, SSc, pSS, RA and SLE had significant increased risk of influenza-related hospitalization. In comparison with each matched controls, PM/DM, SSc and pSS cohorts had even higher IRR than that of the SLE and RA cohorts, whose risks of influenza and the benefit of vaccination were well-known. Considering the risk, patients with these SARDs should follow the recommendations to have influenza vaccine every year and further study about the benefit of vaccine in patients with DM/PM, SSc and pSS are needed. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0797-HPR PREVALENCE AND ASSOCIATIONS WITH DEVELOPMENT OF RADIOGRAPHIC KNEE OSTEOARTHRITIS IN INDIVIDUALS WITH KNEE PAIN – A 2-YEAR FOLLOW-UP
Authors: M. Törnblom, A. Bremander, M. Andersson, A. Nilsdotter, K. Aili, E. Haglund
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Pain and functional impairment form the basis for a clinical knee osteoarthritis (KOA) diagnosis according to the National Institute for Health and Care Excellence (NICE) guidelines [1]. Enhanced knowledge of the progression from knee pain to radiographic KOA (RKOA), may enable early identification of individuals at risk. <h3>Objectives</h3> To study the development of radiographic knee osteoarthritis in individuals with knee pain over time, and its associations to baseline variables. <h3>Methods</h3> In all 172 individuals (30-67 years) with knee pain, from the Swedish HALLOA cohort (2) were studied from baseline to 2-year follow-up. The individuals were at baseline coded as clinical KOA according to NICE guidelines or not. None had RKOA at baseline. At follow-up they were dichotomised as RKOA or not (Ahlbäck grade 1 or more). Self-reported knee symptoms (the Knee injury and Osteoarthritis Outcome Score (KOOS)), and knee pain intensity (numerical rating scale (NRS)) were assessed. Body composition, functional performance and clinical examination were also assessed. The Chi-Square-test or Mann-Whitney U-test was used for comparisons between groups, and logistic regression for analysis of associations between baseline variables and RKOA at follow-up adjusted for age. <h3>Results</h3> The mean age of the group was 51 (SD 8) years, 67% were women, Body Mass Index (BMI) was 26 (SD 5). The prevalence of RKOA at follow-up were 13% (n=23), and all of them had clinical KOA at baseline according to NICE guidelines. Furthermore, those with RKOA at follow-up had significantly higher BMI median 28.8 (IQR 8.6) vs. 25.1 (5.7), p=0.011, visceral fat area (VFA) 130.7 (88.7) vs. 84.7 (62.4), p=0.009, and knee pain; KOOS sub score Pain 69 (28) vs. 78 (19), p=0.016, and pain intensity 5.0 (5.0) vs. 4.0, (3.0) p=0.039, at baseline. Higher BMI and VFA, worse knee pain intensity, and worse KOOS sub scores for Pain, Symptoms, ADL, and QOL at baseline, were associated with RKOA at follow-up (Table 1). Sex, self-reported morning knee stiffness and restricted knee motion, functional performance tests and clinical examined crepitus, were not associated to RKOA and thus not included in the final analysis (p-value 0.477 - 0.930). <h3>Conclusion</h3> More than one out of ten individuals with clinical KOA developed RKOA already in 2 years. In individuals with knee pain, variables associated with RKOA at follow-up can be detected early through NICE guidelines, assessment of BMI, VFA and self-reported symptoms with KOOS questionnaire as a support to start with early management. <h3>References</h3> [1]National Institute for Clinical Excellence. Osteoarthritis in over 16s: diagnosis and management. 2022. [2]M. L. E. Andersson et al. HALLOA cohort profile. BMJ open 2022 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0519 THE ANALGESIC EFFICACY OF THERAPIES USED FOR COMPLEX REGIONAL PAIN SYNDROME: A SYSTEMATIC REVIEW
Authors: C. Shekarsarai, N. Gullick
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Complex regional pain syndrome (CRPS) is a multifactorial chronic pain condition which arises following commonplace injuries such as fractures. Pharmacological and non-pharmacological treatments including physiotherapy have been used to reduce pain but there is an unmet need for novel effective therapies. <h3>Objectives</h3> To review clinical trials for CRPS and evaluate effectiveness for reducing pain. <h3>Methods</h3> A PICO approach was used to search MEDLINE, PubMed, COCHRANE LIBRARY, EMBASE, CINAHL and Web of Science for studies published between 2003 to 2022. Keywords such as "Complex Regional Pain Syndrome", and its previous label "Reflex Sympathetic Dystrophy" were used, alongside "pharmacological" and "non-pharmacological interventions". The studies included were confined to adults clinically diagnosed with CRPS, that were written in English. Additional studies were also found via citation searching of references from eligible reports. <h3>Results</h3> The search strategy generated 41 RCTs in total (Figure 1). Pharmacological interventions such as bisphosphonates showed consistently significant improvement in pain, in addition to ketamine and steroids which yielded some successful outcomes. Interventional therapies such as local anaesthetics, sympathetic blocks, and nervous system stimulations also demonstrated potential. Finally, mirror therapy, motor imagery programs and virtual reality revealed partial improvement. Conversely, Pain Exposure Physical Therapy (PEPT), immunosuppressant drugs, free radical scavengers, anti-convulsants, calcitonin, immunoglobulins, Fluidotherapy and occlusal splints had no significant effects on pain outcomes. The Cochrane risk of bias tool was used to assess the quality of studies involved, for which the lower quality RCTs were those lacking full blinding or selectively reporting outcomes. <h3>Conclusion</h3> Bisphosphonates provide the most consistent benefit in pain reduction in CRPS with larger effects than other interventions. Many studies of other interventions were small or of lower quality. Overall, larger, high-quality trials are required to validate any promising findings for other pharmacological and non-pharmacological therapies. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Charlotte Shekarsarai: None declared, Nicola Gullick Speakers bureau: Speaker fees: Abbvie, Eli Lilly, Janssen, Novartis, UCB, Consultant of: Consultancy fees: Abbvie, Janssen, Novartis, UCB, Grant/research support from: AstraZeneca, Abbvie, Eli Lilly, Izana, Novartis.
POS0798-HPR PREVALENCE OF RISK FOR ANXIETY AND DEPRESSION IN PATIENTS WITH RHEUMATIC DISEASES
Authors: L. F. Vega Sevilla, M. A. Villarreal-Alarcón, D. P. Flores-Gutierrez, N. De Avila Gonzalez, I. D. J. Hernandez-Galarza, J. A. Cardenas-de la Garza, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with chronic diseases have a higher prevalence of anxiety and depression. The complex relationship between chronic diseases and mental health disorders can influence each other negatively. (1) <h3>Objectives</h3> To determine anxiety and depression symptoms prevalence in an out-patient rheumatology clinic, and its associated factors. <h3>Methods</h3> This was a cross-sectional study. Patients &gt; 16 years old with a rheumatologic disease were included. Data from medical history were collected. The Hospital Anxiety and Depression Scale (HADS) was applied from March to November 2022. A score from 0-7 points is classified as low risk, 8-10 as intermediate risk, and &gt;11 as high risk. Patients with high risk were referred to an evaluation by Psychiatry in the same clinic. We compared groups according to HADS scores using Kruskal-Wallis or Chi-square test. <h3>Results</h3> A total of 705 patients were included, 658 women, demographic characteristics in Table 1. Most common diagnosis was RA, followed by systemic lupus erythematosus (SLE). High anxiety risk was found in 125 patients, median disease duration of 6 years. Sixteen patients had high risk for depression, median disease duration of 10 years. Intermediate risk of depression was assessed in 15 patients, median disease duration of 10 years. We received 38 patients that accepted to be referred to a psychiatric evaluation. An association was found between high risk of anxiety and gender (p=0.019), no association was found with age or menopause. High risk of anxiety was more prevalent (n=125) than depression (n=16), and patients with intermediate risk for depression showed a higher prevalence of intermediate and high risk for anxiety (p=.000). <h3>Conclusion</h3> We found that high risk of anxiety was more prevalent than depression. Higher risk of anxiety was found in female patients. Almost 1 of every 5 patients with rheumatic diseases has an intermediate risk for anxiety. The implementation of a mental health screening tool can help patients receive earlier attention by a specialist. <h3>References</h3> [1]Hayward G, Mandela R, Barr A, Freeston J, Vandevelde C, Marzo-Ortega H. Counselling services embedded within rheumatology clinics could help bridge the gap in mental health care provision for adults with rheumatic diseases. Rheumatol Adv Pract. 2022;6(3):rkac080. [2]Maldonado G, Ríos C, Paredes C, Ferro C, Intriago MJ, Aguirre C, et al. Depression in Rheumatoid Arthritis. Revista Colombiana de Reumatología (English Edition). 2017;24(2):84-91. <h3>Disclosure of Interests</h3> None Declared.
POS0819 ALTERED EXPRESSION OF RNA METHYLATION AND DEAMINATION ENZYMES IN SALIVARY GLANDS FROM SJÖGREN’S SYNDROME PATIENTS
Authors: D. Jara, S. Aguilera, P. Carvajal, I. Castro, M. J. Barrera, S. González, C. Molina, R. Soto-Rifo, M. J. González
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by an overactivation of the type I interferon pathway (IFNs I) and differential microRNAs expression in the salivary glands (SG) [1]. In these patients, hsa-miR-145-5p downregulation was found to be associated with increased levels of IFNs I and the overactivation of its pathway [2]. IFNs I can alter miRNA biogenesis by reducing the processing of some primary microRNAs (pri-miRNAs) through diminished interaction with the microprocessor complex, leading to decreased mature microRNA levels [3]. Although the mechanisms involved are not fully understood, changes in adenosine deamination that lead to adenosine to inosine (A-to-I) editing or methylation of the N6-position of adenosines (m6A) in the pri-miRNAs could be participating. <h3>Objectives</h3> To evaluate the expression of pri-miR-145 and the enzymes that methylate (METTL3 and METTL14), demethylate (FTO and ALKBH5), and deaminate (ADAR1p110 and ADAR1p150) adenosines in RNAs of labial SG (LSG) from pSS-patients. <h3>Methods</h3> LSG from 9 pSS-patients and 6 controls as well as HSG cells stimulated with IFNs I (IFN-α or IFN-β) were analyzed. pri-miR-145 levels were determined by TaqMan assays. Enzymes transcript and protein levels were measured by qPCR and Western blot, respectively. The enzymes localization was determined by immunofluorescence. <h3>Results</h3> LSG from pSS-patients showed increased pri-miR-145 levels, which directly correlated with the IFNs I score, a measure of the activation of the IFNs I pathway. LSG from pSS-patients also showed increased METTL3, ALKBH5 and ADAR1p150 levels, with no changes in METTL14 and FTO. ADAR1p150 levels also correlated directly with the IFNs I score. All the enzymes were mainly observed in the nuclei of LSG acinar cells. Finally, stimulation of HSG cells with IFNs I upregulated ADAR1p150 <h3>Conclusion</h3> Increased pri-miR-145 levels suggest accumulation of this precursor in LSG of pSS-patients due to lack of processing, which could contribute to the hsa-miR-145-5p downregulation found previously (2) and could be associated to the overactivation of the IFNs I pathway. The overexpression of METTL3, ALKBH5 and ADAR1p150 could lead to changes in RNA methylation or deamination, particularly in pri-miRNAs that alter their processing, which needs further study. Finally, the functional assays suggest an association between the IFNs I overactivation and the ADAR1p50 overexpression observed in SS-patients. <h3>References</h3> [1]I. Alevizos, et al,. Arthritis Rheum, 2011;63:535-44. [2]Jara et al. Front. Immunol. 2021;12:685837 [3]Witteveldt et al., Cell Reports. 2018:23, 3275–3285 <h3>Acknowledgements</h3> Fondecyt 1210055, Fondecyt 1190156, Fondecyt Iniciación 11201058, CONICYT fellowship (DJ, PC). <h3>Disclosure of Interests</h3> None Declared.
POS0802-HPR SELF-MANAGEMENT SUPPORT NEEDS OF PATIENTS WITH INFLAMMATORY ARTHRITIS AND THE CONTENT OF SELF-MANAGEMENT INTERVENTIONS: A SCOPING REVIEW
Authors: A. Damgaard, J. Primdahl, B. A. Esbensen, K. M. Latocha, A. Bremander
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Studies show varying but beneficial effects of self-management interventions on self-efficacy, symptoms or burdens, such as pain, fatigue, illness perception, and quality of life, supporting the need of multi-disciplinary interventions in rheumatology (1, 2). However, the content of the self-management interventions differs widely [2]. There is a need for an overview of the existing evidence of self-management support needs in patients with inflammatory arthritis (IA) to inform the development of relevant and effective interventions. <h3>Objectives</h3> 1) to identify the evidence for self-management support needs among patients with IA, and 2) to identify the content (theory/theoretical approach, mode of delivery, duration and frequency) of self-management interventions that target patients with IA. <h3>Methods</h3> In May 2021, we performed a scoping review (protocol published at the Open registries network, no. DOI 10.17605/OSF.IO/TVX82)) and conducted a systematic literature search (from 2000 onward) in five databases. <h3>Results</h3> Out of 11,748 records identified, we included 31 articles describing patients' support needs and 33 articles describing the content of self-management interventions (Figure 1). Patients' self-management support needs were categorized into six topics: 1) Disease impact and the pharmacological treatment, 2) Care continuity and relations with health professionals, 3) The importance of non-pharmacological treatment, 4) The need for support from family and friends, 5) Support needs related to work issues, and 6) Contextual preferences for self-management support. Content of the self-management interventions varied widely and the descriptions of the content were deficient and needed clarification (Table 1). The identified topics for support needs were compared with the described content in the included articles (Table 1). Only few self-management interventions focused on patients' need for support concerning work, family, and friends. <h3>Conclusion</h3> Health professionals provided self-management support to patients with IA in various ways. There were gaps between the patients' support needs and the identified interventions. The self-management concept needs to be clearly defined when developing self-management interventions. Further studies are required to investigate various modes of delivery, frequency, and duration to develop effective interventions that meet patients' self-management support needs. <h3>References</h3> [1]Geenen et al. 2018, PMID: 29724726 [2]Marques et al. 2021, PMID: 34049997 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0357 A NOVEL MUTATION IN ALPL GENE CAUSING ADULT AUTOSOMAL DOMINANT HYPOPHOSPHATASIA IN A FAMILY OF SOUTHERN SPAIN: PHENOTYPE CHARACTERIZATION
Authors: S. Leal Rodriguez, N. Roldan Ruiz, L. Mayordomo, J. Bobillo-Lobato
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Tissue non-specific alkaline phosphatase (TNSALP) is essential for bone and tooth extracellular matrix mineralization. The gene encoding TNSALP (ALPL) is located on the long arm of chromosome 2. More than 400 ALPL variants exist. Low enzymatic activity of serum alkaline phosphatase (ALP) due to gene mutations leads to hypophosphatasia (HPP), a heterogeneous clinical condition ranging from asymptomatic or mild adult forms to severe perinatal disease. Adult's HPP most typical features are stress fractures and early loss of dentition. <h3>Objectives</h3> To describe the clinical phenotype and laboratory features in a family suffering from HPP in which a new gene variant was detected. <h3>Methods</h3> A descriptive observational study of a family belonging to the Virgen de Valme Hospital area (Seville) was conducted through a primary identification of an index case with low level of ALP in whom a novel ALPL gene mutation was found. Members from three family generations were screened for low level of ALP to select patients meeting laboratory criteria for HPP. To assess family segregation, phenotype and clinical relevance of this mutation, genetic analysis of those with confirmed low ALP and a selection of members with normal ALP levels was done. Epidemiological, clinical, laboratory and genetic study variables were collected. A descriptive quantitative analysis of the data was performed. <h3>Results</h3> We studied 16 members corresponding to three generations of the same family suspected to have familial hypophosphatasia. The index case was a 57-year-old male with chronic pain, problems with dentition and previous history of fractures. ALP screening found 8/16 (50%) patients with low level. Genetic testing was performed for 7/16 patients and 3/16 with low and normal ALP levels, respectively. A familial carrier variant c.786A&gt;G heterozygotic single-nucleotide polymorphism (SNP) in the ALPL gene was found in all patients with low ALP (Graph 1). Clinical and laboratory features for the seven positive carriers are shown in Table 1. Most fractures were due to non-minor trauma. Chronic arthralgia was the main articular complaint. All laboratory values were within normal range, ruling out secondary causes of HPP. Only one patient presented with high pyridoxal-5'-phosphate (PLP). <h3>Conclusion</h3> We present a new autosomal dominant inheritance mutation in the ALPL gene that causes HPP. Variable clinical expressivity is observed. Dentition problems and recurrent fractures predominate, associated with chronic pain. Early diagnosis and genetic counselling may be important, although further studies and a larger population are required to establish the definitive pathologic relevance of this variant. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.